Provider Demographics
NPI:1528097763
Name:BEARDSLEY, JANET R (ANP-C)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:R
Last Name:BEARDSLEY
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:ME
Mailing Address - Zip Code:04055-5329
Mailing Address - Country:US
Mailing Address - Phone:207-693-6106
Mailing Address - Fax:207-693-4026
Practice Address - Street 1:410 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:ME
Practice Address - Zip Code:04055-5329
Practice Address - Country:US
Practice Address - Phone:207-693-6106
Practice Address - Fax:207-693-4026
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAM082067367A00000X
MECNP121073363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431849899Medicaid
ME431849899Medicare ID - Type Unspecified
MES26010Medicare UPIN